Strange presuppositions

Today’s Guardian is as ever full of fascinations, but this, from a TV review by Mark Lawson struck me as gloriously, perplexingly weird:

The notable balance of the film is shown by the fact that both liberals and conservatives are offered a harrumph-moment: the former when we note that the Guildford Four were locked up for these bombings rather than the people who actually did it, the latter when we learn that those who actually did it were freed from jail as part of the Good Friday Agreement.

It beats me why conservatives should not care about false convictions, nor liberals about murderers being released as part of a dodgy political deal. But then, I do not see liberalism and conservatism as irreconcilable opposites, which is probably why I still have trouble predicting what the PC attitude among media folk will be, even after 20 years of working on the fringe of the media.

Elsewhere in the same issue, the reliably barking John Sutherland takes a story about a US alternative medicine quack, and manages to find it is proof, not of human wickedness and human credulousness, but of the evils of capitalism:

But the runaway success of Natural Cures also bears witness to genuinely troubling aspects of the American healthcare system. It has been estimated that some 50 million citizens have no health insurance. For these desperate people, who fall sick like everybody else, “natural cures” are all they can afford. “Socialised medicine”, as the Clintons learned the hardway, has no place in America. Capitalistic medicine does. What John le Carré calls “Big Pharma” has made America the most drugged nation in history.

Which “explanation”, unfortunately fails to account for some important facts: (1) the purportedly natural non-cures offered by quacks are not generally cheaper than the products of Big Pharma, even at US prices; (2) the most drugged nation in history, is on average (i.e., including all those without health insurance) rather healthier than Britain if you look at survival/recovery patterns for pretty much any disease; (3) The European quack industry is also fabulously successful, and expensive, despite the subsidised competition from socialised medicine.

What is particularly enjoyable about this lunacy is it appears in the same issue of the paper as a nice clear feature by the impeccably rational Dr Ben Goldacre explaining why alternative medicine offers comforts not available from a scientific physician.

August 29th, 2005 |

22 comments to Strange presuppositions

Sutherland also overlooks the fact that in the US medicine is not capitalistic at all. It’s mostly fascist, with large chunks of it socialist. In fact, given the relative populations involved, I’m sure there are more victims patients of the socialist Veterans’ Administration than there are citizens of some of those European countries with socialist medicine.

Its gigglingly funny to think that it is poor people who are buying alternative medicines. In fact, alternative medicines are gobbled down by the affluent “worried well” i.e. people without serious health issues who flit from health fad to health fad as a kind of hobby. The shelves of upscale stores are stuffed with “all natural” crap whereas you see virtually none on the shelves of stores that cater to the poor. (About the only exception to this rule are the traditional remedies of various ethnic groups.) Poor people have neither the time to follow health fads nor the disposable income to blow on ineffective remedies.

There is essentially no difference in health care spending in the USA on younger people and spending on the elderly, who are covered by the socialist Medicare system.

The US has a system where survival and recovery rates for almost all diseases are at the highest in the world, but a higher incidence rate of those disease. Diet and other lifestyle factors are a possible reason why. Also, it’s possible that the much higher rates of diagnostic test use in the USA leads to more trivially small benign cancers and other diseases being noticed and treated, increasing survival rates but also expense. (And in some cases, such treatment is unnecessary.)

I am so sick of this “40-50 million people without health insurance” nonsense. The figure released last year (just before the election, obviously) was 40 million. And that was not 40 million at one time, but 40 million at any point in the previous year. That means that anyone who changed jobs is included. It also includes people who actually got coverage for the first time that year, since they wouldn’t have had it before, and would therefore count as not having it at some point in the year. Also included are teenagers and college students working their first part-time job, who realistically have no need for full medical insurance. This figure is completely irrelevant when discussing US healthcare.

Cynicus Prime – wot you said, plus, I lived in the US for 14 years, and I never once saw anyone die, or even writhe around, on the sidewalks. People without medical insurance can go – or be taken – to a county hospital. They will be seen and treated, in a slightly better time frame, than British people seeking after hours emergency treatment on the NHS.

No health insurance in the US does not mean no medical treatment. It means, it won’t be plush and you’ll have to queue.

The only reason higher proportions of Europeans have healthcare is that they have no choice in the matter whatsoever; you work, you pay. A third of US uninsured make $50k/year or more and can afford health care. They *choose* not to. Which, of course, is a completely aberrant concept to many of the folks who work at The Guardian. What do you mean, people choosing to not do what their betters in the public service believe it is good for them to do ? Outrageous !

Never mind that those numbers have been somewhat obsoleted by recent Medicaid reforms, which extended the program from the poor to lower income families. So now, a family of four with $40,000 a year qualifies for Medicaid insurance for its children; the program now covers 100 million Americans.

Also and despite their supposedly superior health-care system, millions of people in France and elsewhere also pay into complementary health insurance, as the socialised system pays out less and less. With the result that many members of my family pay more, as a percentage of their income, than I ever paid for my health care in the US.

Lastly, one only has to think about what would happen should health insurance become optional in, say, France or Ireland tomorrow, to understand that the difference in coverage has little to do with capitalist greed. Who would be most likely to drop out ? Rich or well-off people for whom a few thousand euro a year make little difference in their lifestyles ? Or young or others on lower incomes for whom those payments could be the difference between taking the bus or driving a car, or between staying in vandalized ‘social’ housing in the suburbs and affording better digs elsewhere ?

No health insurance in the US does not mean no medical treatment. It means, it won’t be plush and you’ll have to queue.

Thank you, Verity. I’ll be stuffing that quote in my arsenal for the next time someone is whingeing about the horrible state of America – just look at their non-socialized healthcare system, beggars dying in streets etc. Naturally, most of these folk have never been to the States.

Sylvain, et al, you have part of the picture. That’s only for children. US also practices “everything for the children” brand socialism. Some of us are not children. We still may need medical care. What about us?

In reverse order of importance. First, we small business owners have to pay income taxes on our medical insurance. Big Business doesn’t. Second, Big Business does large competitively negotiated group purchases. Complicated laws effectively prevent us little guys from banding together and doing that. Third, if you purchase medical service directly for cash expect to pay as much as 5 times what an insurance company would pay for the exact same service. They buy in quantity and negotiate huge discounts. I was astounded when I was processing my dad’s medical bills and learned this. It’s a well kept secret. Fourth, if you develop an ongoing need for the insurance, like cancer, and it drags on, they can raise your premiums without recourse and effectively deny you insurance. Insurance doesn’t mean protection against bills, it means protection against bills until renewal time.

So, there always Medicaid, right?

In our state in 1999, you must have monthly income below, and household goods and personal assets less than the numbers in these columns. And yes it only adds up to 30,000 for ‘group’ of four so the numbers are older than in your newspaper. http://www.legalaction.org/medicaid2.htm(Link) Sounds pretty spartan, but hey, you get to “keep” your house, right? Except, there is a lien against your house and –

“Medicaid liens protect Medicaid’s interest in the recipient’s former home and its right to recover Medicaid spending before the property can be conveyed to another party. Liens in themselves do not force recipients to sell their property. They may, however, prevent property from being given away or sold at less than fair market value and ensure that equity in the home is available to reduce Medicaid spending on the homeowner’s behalf.”
from http://aspe.hhs.gov/daltcp/reports/liens.htm(Link)

If my mother ever needs Medicaid, two generations of family savings in the form of cash-etc, farmland, house and buildings is gone. There is, of course, a whole industry of professionals willing to help you beat the system for a fee. Even the best of the plans will probably not work for an unexpected illness. You have to anticipate when you will get sick and divest your assets years in advance.

A large tranche of uninsured Americans are under 30 – unemployed, self-employed or working for small firms that can’t afford to offer health and dental. People under 30 don’t get sick very often and when they do get sick, it is – barring tragic cases of cancer or other life-threatening conditions – fairly minor and cheap to get treated.

Another large tranche of insured are people earning $50K or considerably more, who have assets. They can pay for their own treatment. In the case of major medical, increasing numbers of them are going to the 20 or so (so far) American-style hospitals in India, where they are treated, in American comfort, for around 1/3 the cost of identical treatment in the US. They’re going for cosmetic dental work, too. Heart bypasses, kidney treatment, including transplants, liver treatment, eye surgery, fertility treatment – everything available in the West, done by skillful Indian surgeons. India’s medical “greet ‘n’ treat” health industry is currently worth $US2bn a year to the country and will grow to around $10bn in a few years. Many patients return when they need treatment for an unrelated ailment.

People in the US first found out about this when their NRI (Non-Resident Indian) colleagues were returning “home” for surgery rather than being treated in the US – or they have an Indian doctor in the US who has told them about it, and it has caught on. There are now two sophisticated hospital chains in India that are covered by Blue Cross/Blue Shield.

More and more British are skipping NRI hospital waiting lists and using their own funds to get immediate and economically viable treatment in India – especially heart patients. In some cases, the NHS is now, in many instances, covering some of the costs.

The more people go outside the NHS, the less valid it will become. Then maybe our tax will be released, and we can all choose clean hospitals where staff treat us as customers, not someone they are doing a favour for.

Looking back I think Ken Hagler’s post is exactly right. It’s the first one in the thread.

And Verity, I’m with Tim. That is good news and can only be a good thing. Can you tell us any more? And for us under 50,000 types, could it still make good math? Seems if someone needs enough care, airfare and housing should be a small trade.

And if enough people do it, the competition would help things back here.

Tim and Midwesterner – I read an article, I don’t remember where, about a year ago and was very impressed. I was thinking of moving to India at the time, so did some research. I Googled India health tourism and India medical tourism and there’s a huge amount of information, including cost charts. After I found out that foreign nationals can’t buy property in India, I lost interest, but there’s yards of information available on the net.

James Bartholomew (author of “the welfare state we’re in”) has drawn attention to the fact that many Europeans are under the impression that Americans don’t get medical cover if they don’t have private insurance – although this isn’t the case and overall the US system delivers better outcomes across the board than the NHS.

I’m also not sure that it’s accurate to describe European healthcare systems as “socialised” in contrast to that in the US. In fact, the US government spends a substantial proportion of its budget (similar to many European countries) on Medicaid and Medicare and many European countries have substantial private sectors – the distinction is not black and white.

Anyway, anyone who thinks that medics are the prime contributor to health is a fool. The NHS is not a health system, it’s a sickness and emergency system. The prime factor in health in most cases is lifestyle – e.g. diet and exercise. Medicine in most cases is an expensive palliative – especially when you take misdiagnosis, drug side effects, hospital acquired infections, etc. into account which, overall, severely reduce the effectiveness of medical intervention.

Somehow we have allowed the medical monopoly in most western countries to convince us (or force us) to pay sky high prices for their often questionable services while they are shielded from global economic forces that act as a restraint on the prices that most of us can charge for our services. Blair recently boasted (in the Queen’s speech debate) that British GPs are now paid twice what they are in France – why is this meant to be good? I’d prefer them to be cheaper than in France as I’m paying their bloated wages from my taxes (the average GP in the UK now makes over £100k/year and can retire at 60 on a generous taxpayer-funded index linked pension) and we’re always told that the NHS can’t afford enough of them. The same doctor would only be paid 10% of this in India.

This is why medical schools and law courses in the west are flooded with applications – these ‘professions’ can charge what they like as they don’t have to worry about international competition. They don’t require the same level of intellect as many science and engineering courses, yet are paid far more because the ‘goods’ they produce aren’t generally internationally tradeable (although I hope this will change). The rest of us are all poorer for the medical monopoly.

I think people should be allowed to spend their money on quack medicine if they want, too. However, I’m fairly sure that causing indirect harm to others by fraudulent or reckless medical claims ought to be punished just like equivalent harms caused by the deliberate or reckless application of physical force.

Where to draw the line beyond which conduct is culpable is difficult to know. But inside that line I reserve the right to despise mediums and healers and mock their customers, even while I think the trade may be legitimate and that fools are entitled to spend their money foolishly.

You aren’t entitled to ban something merely because you don’t like it. Just because I think something ought to be allowed doesn’t mean I have to like it or keep quiet about it.

Who Are We?

The Samizdata people are a bunch of sinister and heavily armed globalist illuminati who seek to infect the entire world with the values of personal liberty and several property. Amongst our many crimes is a sense of humour and the intermittent use of British spelling.